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Teyton A, Ndovu A, Baer RJ, Bandoli G, Benmarhnia T. Disparities in the impact of heat wave definitions on emergency department visits during the first year of life among preterm and full-term infants in California. ENVIRONMENTAL RESEARCH 2024; 248:118299. [PMID: 38272297 DOI: 10.1016/j.envres.2024.118299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Heat waves will be aggravated due to climate change, making this a critical public health threat. However, heat wave definitions to activate alert systems can be ambiguous, highlighting the need to assess a range of definitions to identify those that contribute to the most adverse health outcomes. Additionally, children are highly susceptible to the impacts of heat waves, especially infants, despite the lack of focus on this subpopulation. We aimed to assess the relationship between 30 heat wave definitions and the first all-cause emergency department (ED) visits for California infants. We also examined modification of this relationship by preterm birth status and demographic characteristics to identify possible health disparities. METHODS Live-born, singleton deliveries from the Study of Outcomes in Mothers and Infants born in 2014-2018 were included. Thirty heat wave definitions were assessed based on temperature metrics (minimum/maximum temperatures), thresholds (90th; 92.5th; 95th; 97.5th; 99th percentiles), and duration (1-; 2-; 3-days). A time-stratified case-crossover design assessed heat wave impacts on ED visits using infants with a warm season ED visit (May-October) within the first year of life (n = 228,250). Effect modification by preterm birth status, age, sex, race/ethnicity, education, and delivery payment type was also investigated. RESULTS Infants demonstrated increased risk of an ED visit with exposure to all heat definitions. The 3-day minimum temperature 99th percentile definition had the highest adjusted odds ratio (AOR: 1.14; 95% CI: 1.05-1.23) for the total population. Term infants were more affected by some heat waves than preterm infants. Effect modification was additionally identified, such as by maternal education. DISCUSSION This study provides insight on the heat wave definitions that lead to adverse health outcomes and the identification of the most susceptible infants to these impacts, which has implications on heat-related interventions.
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Affiliation(s)
- Anaïs Teyton
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA; Scripps Institution of Oceanography, University of California, San Diego, 8885, Biological Grade, La Jolla, CA, 92037, USA.
| | - Allan Ndovu
- University of California San Francisco School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Rebecca J Baer
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr. 9 Box 2930, San Francisco, CA, 94143, USA; Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Gretchen Bandoli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, 8885, Biological Grade, La Jolla, CA, 92037, USA
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Tu L, Marzouk S, Dowdell KN, Stanford FC. Reimagining Urban Spaces: Green Spaces, Obesity, and Health Resilience in an Era of Extreme Heat. J Urban Health 2024; 101:344-348. [PMID: 38441853 PMCID: PMC11052730 DOI: 10.1007/s11524-024-00834-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 04/02/2024]
Abstract
Record-breaking heat waves intensified by climate change pose both environmental and health threats, necessitating a balance between urban sustainability and well-being. Extreme heat and limited green space access are drivers of obesity prevalence, with decreased proximity to green spaces correlating with higher rates of obesity in nearby communities. In contrast, access to such green spaces fosters physical activity, well-being, and community cohesion, especially crucial in marginalized communities facing health disparities due to historical policies like redlining and underinvestment in social gathering spaces. Despite challenges, green space investment offers healthcare savings and environmental gains, necessitating a shift in perception towards viewing green spaces as essential for urban living. As heat waves persist, integrating health and sustainability in urban planning is paramount. Health and medical communities must play an active role in advocating for equitable access to urban green spaces, as they possess influential positions to address climate-related health disparities through localized advocacy.
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Affiliation(s)
- Lucy Tu
- Department of Sociology, Harvard College, Cambridge, MA, USA
- Department of the History of Science, Harvard College, Cambridge, MA, USA
| | - Sammer Marzouk
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Kimberly N Dowdell
- HOK Architects, American Institute of Architects (AIA), Chicago, IL, USA
| | - Fatima Cody Stanford
- Division of Endocrinology-Neuroendocrine, Department of Medicine, MGH Weight Center, Massachusetts General Hospital, Boston, MA, USA.
- Division of Endocrinology, Department of Pediatrics, Nutrition Obesity Research Center at Harvard (NORCH), Massachusetts General Hospital, Boston, MA, USA.
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Wilken JA, Huff ME, Baja K, Balbus J. Building Local Climate Health Equity Into a Resilience Hub Framework. Public Health Rep 2024; 139:145-148. [PMID: 38044634 PMCID: PMC10851893 DOI: 10.1177/00333549231210248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Jason A. Wilken
- Office of Climate Change and Health Equity, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC, USA
- US Public Health Service, Rockville, MD, USA
- Center for Healthy Communities, California Department of Public Health, Richmond, CA, USA
- Career Epidemiology Field Officer Program, Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael E. Huff
- Office of Field Policy and Management, Region 9, US Department of Housing and Urban Development, San Francisco, CA, USA
| | - Kristin Baja
- Urban Sustainability Directors Network, Sanford, NC, USA
| | - John Balbus
- Office of Climate Change and Health Equity, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC, USA
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Shindell D, Hunter R, Faluvegi G, Parsons L. Premature Deaths Due To Heat Exposure: The Potential Effects of Neighborhood-Level Versus City-Level Acclimatization Within US Cities. GEOHEALTH 2024; 8:e2023GH000970. [PMID: 38169989 PMCID: PMC10759151 DOI: 10.1029/2023gh000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
For the population of a given US city, the risk of premature death associated with heat exposure increases as temperatures rise, but risks in hotter cities are generally lower than in cooler cities at equivalent temperatures due to factors such as acclimatization. Those living in especially hot neighborhoods within cities might therefore suffer much more than average if such adaptation is only at the city-wide level, whereas they might not experience greatly increased risk if adjustment is at the neighborhood level. To compare these possibilities, we use high spatial resolution temperature data to evaluated heat-related deaths assuming either adjustment at the city-wide or at the neighborhood scale in 10 large US cities. On average, we find that if inhabitants are adjusted to their local conditions, a neighborhood that was 10°C hotter than a cooler one would experience only about 1.0-1.5 excess heat deaths per year per 100,000 persons. By contrast, if inhabitants are acclimatized to city-wide temperatures, the hotter neighborhood would experience about 15 excess deaths per year per 100,000 persons. Using idealized analyses, we demonstrate that current city-wide epidemiological data do not differentiate between these differing adjustments. Given the very large effects of assumptions about neighborhood-level acclimatization found here, as well as the fact that current literature is conflicting on the spatial scale of acclimatization, more neighborhood-level epidemiological data are urgently needed to determine the health impacts of variations in heat exposure within urban areas, better constrain projected changes, and inform mitigation efforts.
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Affiliation(s)
- D. Shindell
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - R. Hunter
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - G. Faluvegi
- NASA Goddard Institute for Space Studies and Center for Climate Systems ResearchColumbia UniversityNew YorkNYUSA
| | - L. Parsons
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
- Global ScienceThe Nature ConservancyDurhamNCUSA
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Sullivan J, Sorensen C. Protecting populations from the health harms of air pollution. BMJ 2023; 383:2020. [PMID: 37793680 DOI: 10.1136/bmj.p2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- James Sullivan
- Global Consortium on Climate and Health Education, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Cecilia Sorensen
- Global Consortium on Climate and Health Education, Mailman School of Public Health, Columbia University, New York, NY, USA
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Filippelli GM. Our Hot Future Has Arrived-Are We Prepared? GEOHEALTH 2023; 7:e2023GH000936. [PMID: 37736250 PMCID: PMC10511238 DOI: 10.1029/2023gh000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
Climate change has significantly enhanced dangerous heat events. Many of our institutions are ill-prepared to provide science-informed and rapid interventions to confront this. The GeoHealth community is working to bring science, public health, and medical professionals closer together to grapple with the challenges posed by extreme heat.
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Cleland SE, Steinhardt W, Neas LM, Jason West J, Rappold AG. Urban heat island impacts on heat-related cardiovascular morbidity: A time series analysis of older adults in US metropolitan areas. ENVIRONMENT INTERNATIONAL 2023; 178:108005. [PMID: 37437316 PMCID: PMC10599453 DOI: 10.1016/j.envint.2023.108005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 07/14/2023]
Abstract
Many United States (US) cities are experiencing urban heat islands (UHIs) and climate change-driven temperature increases. Extreme heat increases cardiovascular disease (CVD) risk, yet little is known about how this association varies with UHI intensity (UHII) within and between cities. We aimed to identify the urban populations most at-risk of and burdened by heat-related CVD morbidity in UHI-affected areas compared to unaffected areas. ZIP code-level daily counts of CVD hospitalizations among Medicare enrollees, aged 65-114, were obtained for 120 US metropolitan statistical areas (MSAs) between 2000 and 2017. Mean ambient temperature exposure was estimated by interpolating daily weather station observations. ZIP codes were classified as low and high UHII using the first and fourth quartiles of an existing surface UHII metric, weighted to each have 25% of all CVD hospitalizations. MSA-specific associations between ambient temperature and CVD hospitalization were estimated using quasi-Poisson regression with distributed lag non-linear models and pooled via multivariate meta-analyses. Across the US, extreme heat (MSA-specific 99th percentile, on average 28.6 °C) increased the risk of CVD hospitalization by 1.5% (95% CI: 0.4%, 2.6%), with considerable variation among MSAs. Extreme heat-related CVD hospitalization risk in high UHII areas (2.4% [95% CI: 0.4%, 4.3%]) exceeded that in low UHII areas (1.0% [95% CI: -0.8%, 2.8%]), with upwards of a 10% difference in some MSAs. During the 18-year study period, there were an estimated 37,028 (95% CI: 35,741, 37,988) heat-attributable CVD admissions. High UHII areas accounted for 35% of the total heat-related CVD burden, while low UHII areas accounted for 4%. High UHII disproportionately impacted already heat-vulnerable populations; females, individuals aged 75-114, and those with chronic conditions living in high UHII areas experienced the largest heat-related CVD impacts. Overall, extreme heat increased cardiovascular morbidity risk and burden in older urban populations, with UHIs exacerbating these impacts among those with existing vulnerabilities.
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Affiliation(s)
- Stephanie E Cleland
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Oak Ridge Institute for Science and Education at the Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - William Steinhardt
- Oak Ridge Institute for Science and Education at the Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Lucas M Neas
- Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - J Jason West
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ana G Rappold
- Center for Public Health and Environmental Assessment, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, NC, USA.
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Parsons LA, Lo F, Ward A, Shindell D, Raman SR. Higher Temperatures in Socially Vulnerable US Communities Increasingly Limit Safe Use of Electric Fans for Cooling. GEOHEALTH 2023; 7:e2023GH000809. [PMID: 37577109 PMCID: PMC10413955 DOI: 10.1029/2023gh000809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/09/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023]
Abstract
As the globe warms, people will increasingly need affordable, safe methods to stay cool and minimize the worst health impacts of heat exposure. One of the cheapest cooling methods is electric fans. Recent research has recommended ambient air temperature thresholds for safe fan use in adults. Here we use hourly weather reanalysis data (1950-2021) to examine the temporal and spatial evolution of ambient climate conditions in the continental United States (CONUS) considered safe for fan use, focusing on high social vulnerability index (SVI) regions. We find that although most hours in the day are safe for fan use, there are regions that experience hundreds to thousands of hours per year that are too hot for safe fan use. Over the last several decades, the number of hours considered unsafe for fan use has increased across most of the CONUS (on average by ∼70%), with hotspots across the US West and South, suggesting that many individuals will increasingly need alternative cooling strategies. People living in high-SVI locations are 1.5-2 times more likely to experience hotter climate conditions than the overall US population. High-SVI locations also experience higher rates of warming that are approaching and exceeding important safety thresholds that relate to climate adaptation. These results highlight the need to direct additional resources to these communities for heat adaptive strategies.
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Affiliation(s)
- L. A. Parsons
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
- Global ScienceThe Nature ConservancyDurhamNCUSA
| | - F. Lo
- Environmental Defense FundNew York CityNYUSA
| | - A. Ward
- Nicholas Institute for Energy, Environment, and SustainabilityDuke UniversityDurhamNCUSA
| | - D. Shindell
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - S. R. Raman
- Population Health SciencesDuke UniversityDurhamNCUSA
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